Experience with transvenous lead extraction of His bundle pacing leads.

Background: Nowadays, we observe a growing interest in conduction system pacing (CSP). Therefore, we expect the number of patients with CSP to increase significantly in the coming years. However, there is a lack of large data on transvenous lead extraction (TLE) procedures of CSP leads, particularly His bundle pacing (HBP) leads in the adult population.

Aims: This study aimed to present the experience of performing TLE procedures in patients with CSP leads using a non-stylet-driven Medtronic 3830 lead in two tertiary lead extraction centers in Poland.

Methods: A prospective analysis of the records involved of all patients with HBP leads who underwent TLE from October 2011 to November 2023.

Results: The study involved 38 patients, at a median (interquartile range [IQR]) age of 69.7 (65.6-76.0) years, 8 of whom were female (21.1%). The median (IQR) lead dwell time was 15.5 (8.7-19.8) months. Thirty leads were removed using simple traction, while 8 leads required mechanical extraction tools. All leads with lead dwell time over 42 months required mechanical extraction tools. The median (IQR) fluoroscopy time was 1.03 (0.07-11.5) min. There were no intra-procedural major or minor complications. Radiological and clinical success was achieved in 100% of targeted CSP leads.

Conclusion: TLE from the His bundle and left bundle branch region is a safe and effective procedure, with no lasting damage to the His-Purkinje system. Successful re-implantation of the lead in the His-Purkinje conduction system is possible in most cases.